Abstract 18742: Exercise Echocardiography with Speckle-Tracking Derived Strain and Strain-Rate Analysis Allows Detection of Heart Transplant Recipients with Focal Coronary Stenoses
Background: Transplant vasculopathy (TVP) is a major cause of graft failure after heart transplantation (HTx). Coronary angiography (CA) is necessary for TVP diagnosis but TVP surveillance by frequent angiographies is risky, especially for patients with renal dysfunction. Timing of CA by non-invasive methods especially by stress echocardiography (stressecho) thus appears necessary. Unfortunately, visual echo assessment of cardiac wall motion is highly operator dependent and allows only limited evaluation of radial deformation and no assessment of longitudinal shortening. This study assessed the usefulness of strain imaging for detection of exercise-induced left ventricle (LV) myocardial contraction abnormalities.
Methods: HTx patients with known and unknown TVP (n = 20) underwent exercise stress-echo before their routine follow-up CA. A cohort of 20 healthy persons underwent the same stress-echo investigation. In all patients, the two-dimensional (2D) echo-loops acquired at unloaded phase, low load, peak load and recovery phase were analyzed by speckle tracking derived strain imaging. In the 20 HTx patients, longitudinal, radial and circumferential strain and strain rate data were tested for relationship with CA findings.
Results: Global strain and strain-rate values were lower in HTx patients (p<0.05). In all healthy patients, strain and strain rate values remained unchanged during exercise testing. In HTx patients, myocardial segments supplied by coronaries with focal proximal stenoses (>50% narrowing) showed significant reduction in longitudinal strain and strain-rate, although conventional 2D-echo revealed no visually detectable regional wall motion alterations. Longitudinal strain and strain-rate showed the highest predictive value for new appearance of coronary stenoses and/or aggravation of preexistent stenoses.
Conclusion: Quantitative segmental myocardial deformation analysis of LV loops acquired during exercise echocardiography using speckle tracking derived 2D strain imaging is effective for detection of coronary stenoses in HTx patients even before regional wall motion disturbances become visible. This analysis provides potentially useful information for non-invasive timing of coronary angiography.
- Coronary heart disease
- Stress echocardiography
- Strain rate
- Transplantation/medical aspects
- Ventricular function
Author Disclosures: S. Hussein: None. M. Dandel: None. R. Hetzer: None.
- © 2014 by American Heart Association, Inc.